First Name *

Last Name *

Date of birth *

Social Security Number (optional)

Phone *

Preferred Contact Method *

Phone

Text

Email *

Address *

Street Address *

City *

State *

Country *

Country

Postal Code *

What is your current credit score range? *

Below 500

500 – 579

580 – 669

670 – 739

740 – 799

800+

Do you know of any derogatory marks on your credit report? (Check all that apply) *

Late Payments

Collections

Charge-Offs

Bankruptcies

Judgments/Liens

None

What’s your biggest challenge with credit? *

Low Score

High Debt

No Credit History

Errors on Credit Report

Other

Have you worked with a credit repair company before? *

Yes

Are you actively monitoring your credit? *

Yes

What is your short-term credit goal? *

Buy a Home

Buy a Car

Qualify for Credit Cards/Loans

Reduce Debt

Improve Score for Business Credit

Other

What is your current monthly income? *

What are your total monthly expenses? *

Do you currently have a budget in place? *

Yes

How would you rate your financial discipline? *

Excellent

Good

Fair

Poor

We offer 6 Month, 9 Month & 12 month plans which are you interested in. This includes onboarding and financial assessment to help you become debt free. Services start at $500 & Up *

We also Accept: *

Klarna

Afterpay

Affirm

Do you have any outstanding debts in collections? *

Yes

Do you have an emergency fund covering 3–6 months of expenses? *

Yes

How important is improving your credit to you? *

Extremely Important

Important

Somewhat Important

Not Important

How soon are you ready to start improving your credit? *

Immediately

Within 1 Month

3–6 Months

Just Exploring Options

Do you plan to make any major financial decisions in the next 6–12 months? *

Yes

If Yes, Explain: *

Are you willing to commit to improving your credit with professional help? *

Yes

Would you like to schedule a free consultation to discuss your options? *

Yes

Would you like to explore 0% interest financing for your credit services? *

Yes

Preferred Payment Method *

Credit/Debit Card

Bank Transfer

Financing

Would you be open to a customized payment plan? *

Yes

Check *

I authorize The Tolbau Group to contact me regarding credit restoration services and understand that my information will be kept confidential.

Signature *

Clear

Sign here

Sign Date *

By submitting this form, you agree to receive SMS text messages from The Tolbau Group for appointment reminders, promotions, updates, and customer support.

Message and data rates may apply. You may reply STOP to opt out or HELP for assistance at any time. You must be 18 years or older to opt in. Your SMS consent and personal information will not be shared with third parties or affiliates.